Active NPI
Emily Marie Clark
- Social Worker
- Portland, OR
National Provider Identifier
1760882500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 2901 E Burnside St
Portland, OR 97214-1831 - Phone
- (503) 238-5203
- NPI assigned
- Aug 29, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary | ||
| Clinical Social Worker | 1041C0700X | A4153 | OR |
Addresses
Primary practice location
2901 E Burnside St
Portland, OR 97214-1831
Mailing address
2901 E Burnside St
Portland, OR 97214-1831
Phone (503) 238-5203
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A4153 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492560000000",
"number": "1760882500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141831",
"telephone_number": "503-238-5203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141831",
"telephone_number": "503-238-5203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "EMILY",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-29",
"last_updated": "2017-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "A4153",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.